Maine health system dumps eICU service, citing sustainability issues

From the mHealthNews archive
By Eric Wicklund
11:01 am

Citing budget restraints and a lack of reimbursement, MaineHealth has announced plans to shut down its VitalNetwork telemedicine program.

The Portland, Maine-based non-profit healthcare system made the announcement on August 2, saying the eight-year-old critical care monitoring platform, now in use in nine hospitals around the state, would be closed on October 1.

"It was a very difficult choice for us," Vance Brown, MD, MaineHealth's chief medical officer, said in a press release. "The leadership of the participating hospitals and MaineHealth carefully reviewed all of our options."

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The participating hospitals – four of which are outside the MaineHealth administrative network – pay a fee to access VitalNetwork. MaineHealth officials say the cost of running the network, combined with the fact that there is no reimbursement from insurers for those services, made the program financially unsustainable. Some estimates have said MaineHealth would face a deficit of $500,000 a year to keep it going.

MaineHealth officials said they looked at spreading the cost among participating organizations, enlisting new hospitals and reducing hours of operation or staff, but decided none of those options would ensure the program's sustainability.

"The option of closing the program wasn't considered lightly," Brown added in the press release. "VitalNetwork's team of specially trained physicians and nurses have successfully managed and run a program that provides an added level of support to the hospitals' critical care team."

Launched in 2005 in a partnership with VISICU, a Maryland-based eICU provider and subsidiary of Philips, VitalNetwork's platform collects vital signs and other medical information from patients in each hospital's intensive care unit. That information is made available to eICU specialists based in a so-called 24-hour "command center" in Portland, who can then consult with physicians and nurses at the scene and even interact via video connections at the patient's bedside.

MaineHealth officials said the network helps hospitals in Maine's more remote locations that don't have the resources to include ICU specialists on their staff, as well as those who need after-hours assistance.

According to a 2012 study by the New England Healthcare Institute, eICU units can cost anywhere between $6 million and $8 million to establish, not including staff salaries, while satellite hospitals might incur as much as $500,000 to join.

In a recent story in MedCity News, officials at Franklin Memorial Hospital in Farmington, which joined the VitalNetwork about four years ago and has four ICU beds, said they spend $100,000 to $150,000 a year to participate in the network.

"While the service is fantastic for our patients, it's not reimbursable," Chief Information Officer Ralph Johnson said in the story. "As with most of the hospitals around the state … we had to trim a number of expenses, and I'm sure MaineHealth faced the same thing."

Aside from Franklin Memorial, other hospitals using VitalNetwork are Maine Medical Center and Mercy Hospital in Portland, Southern Maine Medical Center in Biddeford, MaineGeneral Medical Center in Waterville, Miles Memorial Hospital in Damariscotta, Penobscot Bay Medical Center in Rockport, St. Mary's Regional Medical Center in Lewiston and Waldo County General Hospital in Belfast.

MaineHealth officials said they are "investigating options for those organizations that would like to continue to (provide) a critical care monitoring system, which will likely involve connecting those hospitals to another organization."

Telemedicine advocates have long argued that services like those that eICUs provide won't be easy without buy-in from the federal government and insurers, both of which are hesitant to offer financial support. That point was made in 2010 at a telehealth summit held at the University of Maine in Orono by Dale Alverson, MD, then-president of the American Telemedicine Association, and Charles Dwyer, director of the Maine Center for Disease Control's Office of Rural Health and Primary Care.

“What’s hindering the development of telemedicine? What’s hindering the sustainability of it?” Dwyer asked at the conference of about 150 providers and advocates. “Obviously, the big barrier is reimbursement.”

“How do we equitably pay providers?” added Alverson, medical director of the Center for Telehealth and Cybernetics Research at the University of New Mexico’s Health Sciences Center.

An April 14 story in the New York Times by Nina Bernstein indicated the "command center" approach for eICUs was popular a decade ago, but has since stalled to a growth rate of about 10 percent.

"There's still legitimate concern about whether there's any improvement as far as patient care," Michael P. Hughes, a spokesman for Kaleida Health, a Buffalo, N.Y.-based health system that experimented with tele-ICU but eventually pulled the plug on the project, told the Times. "We studied it, and there was no statistically significant improvement in the mortality rate and complication rate over a 12-month period. We discontinued it and moved that personnel back to the bedside."

Still, Bernstein cited "wildly contradictory studies about the results" of eICU systems in her story and suggested that the jury is still out on their efficacy. And participants in a session at the ATA's annual conference this past May in Austin, Texas, painted a rosy picture for the future of eICUs.

Theresa Davis, RN, clinical operations director for the enVision eICU at Inova Health in Falls Church, Va., said her organization drew up the specific definition of its own tele-ICU: "A network of visual communication and computer systems which provide the foundation for a collaborative inter-professional care model focusing on critically ill patients."

"ROI is the most challenging piece of all of this because it's hard to prove where those benefits occurred. Was it the tele-ICU or the ICU? Or was it what the tele-ICU and the ICU did together?" Davis asked at the ATA session. "But I'm here to tell you, it's the last one. … If you build those relationships and you integrate those teams and you use the technology, you will see improved outcomes."

Brown said the lessons learned in the eight years that the VitalHealth Network has been up and running – as well as the technological advances made in telemedicine – will help those hospitals after the platform shuts down.

"VitalNetwork doesn't replace the personal care provided at the bedside by the critical care staff," he pointed out in the press release. "Also, in the eight years since MaineHealth VitalNetwork was launched, much has changed in ICUs. The lessons learned by our ICU staff have helped us serve our patients even better, including improved infection control, reduced ventilator days, reduced instances of ventilator-acquired pneumonia and reduced blood transfusions, and these improvements will continue."


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